What is the optimum diet for asymptomatic HIV-infected people (AHIV)? : a public health approach / Averalda Eldorine van Graan

Abstract:

OBJECTIVE: The main aim of this thesis was to investigate the role of nutrition during "early" HIV-infection in African women.
METHODS: Data reported in this investigation formed part of two cross-sectional studies, the THUSA
and Mangaung studies. The Mangaung study investigated women and, therefore, the
sub-sample of the THUSA study was chosen accordingly. The data of the two studies
were kept and analysed separately.
The investigation consisted of 1040 women from the THUSA study, aged between 15
and 90 years of which 120 (11.5%) were HIV infected. The Mangaung study comprised
of 488 women aged between 25 and 44 years of which 248 (51%) women were infected.
Demographic data, anthropometric measurements, health outcome variables and
habitual nutrient intakes by a quantified food frequency questionnaire were used.
The SPSS statistical package (version 14.0; SPSS Inc., Chicago, Illinois, 2005) was used
to analyse data. Descriptive statistics were done expressing variables as means,
medians, standard deviations (SD), standard errors (SE) and confidence intervals (CI).
An analysis of variance (ANOVA) was done to test for significance between the HIV-infected
and non-infected groups in both studies. Partial correlations were done in the
infected and non-infected groups to determine associations between dietary / nutrient
intake, anthropometry and the biological health variables. In the THUSA study we
controlled for age, education level, degree of urbanization and alcohol intake and in the
Mangaung study for age, education level and alcohol intake. Nutrient intakes of both
infected and non-infected women above and below median values as well as in the first
and fourth quartile of total cholesterol (TC) and albumin distribution were compared to
assess the role of nutrients in the observed decreases in TC and albumin of HIV-infected
women.
RESULTS AND DISCUSSION: The dietary intakes of the HIV-infected women in both the studies did not differ
significantly from the non-infected women. Total serum cholesterol, albumin, fibrinogen
and blood pressure were significantly lower in the HIV-infected women in both the
THUSA and Mangaung studies.
The non-infected THUSA women with lower serum cholesterol levels (than the median)
had significantly lower intakes of percentage energy from fat (25.2 versus 26.4%, p
≤0.027), percentage energy from total protein (11.6 versus 12.1%, p≤0.000), animal
protein (25.6 versus 27.7g, p≤0.005), and significantly higher intakes of plant protein
(32.2 versus 29.4g, p≤0.002) and fibre (16.9 versus 15.89 p≤0.029). There were no
significant differences observed in the nutrient intakes in the infected women with serum
cholesterol levels above and below the median. In the Mangaung study no significant
nutrient intake differences were observed in both of the HIV-infected and non-infected
women with lower and higher than the median TC levels.
In the THUSA study, higher intakes of fat (percentage energy) were close to significant
(27.3 versus 24.5%, p≤0.053) in the infected women with higher (than the median)
albumin levels. In the non-infected group with higher albumin levels, significant
differences were observed in percentage energy from fat (26.6 versus 24.9%; p≤0.001)
protein (12.2 versus 11.6%; p≤0.001) and carbohydrate (62.8 versus 65.2%; p≤0.000).
Higher intakes of saturated fat (SATFAT) (17.7 versus 16.1g, p≤0.008),
monounsaturated fats (MUFAT) (19.3 versus 17.4g, p≤0.004) as well as higher intakes
of animal protein (28.5 versus 24.4g, p≤0.000) were observed in the group with higher
than the median levels of serum albumin. In the Mangaung study the HIV-infected
women (with higher than the median serum albumin levels), had significantly higher
intakes of energy (13 275 versus 11 622 kJ, p≤0.022), polyunsaturated fatty acids (32.3
versus 17.3g, p≤0.036), dietary cholesterol (412.9 versus 344.5mg, p≤0.043) and
plant protein (42.3 versus 35.3g, p≤0.008). No differences were observed in the non-infected
women.
The further analyses, comparing the dietary intakes in both studies of infected and non-infected
women with TC and albumin levels in the first and fourth quartiles, showed that
in the THUSA study, non-infected women with lower TC levels had significantly lower
intakes of protein (% of total energy), total fat (% of total energy) and vitamin B12 and
significantly higher intakes of total energy (TE), plant protein, total carbohydrate, % TE
from carbohydrate, dietary fibre, added sugar and thiamine. In the infected women
saturated fatty acids (SATFAT), calcium and the fat ratio (polyunsaturated/saturated
ratio) differed significantly between women with TC levels in the first and the fourth
quartile. A significant higher intake of riboflavin was seen in the non-infected women
from Mangaung with TC levels in the fourth quartile, while significant higher intakes of
energy, total protein, animal protein, total fat, SATFAT, MUFAT, total carbohydrate,
phosphorus, chromium and iodine was seen in the infected women with TC levels in the
fourth quartile. These results suggest that a more "westernized" diet with higher intakes
of energy, and animal derived foods (SATFAT and calcium) could have protected
against the detrimental decreases in TC observed in HIV infection. Significant
differences were observed in the intakes in the non-infected THUSA women who had
serum albumin in the first and fourth quartiles. lntakes in percentage energy from protein
and fat, animal protein, total fat, SATFAT, MUFAT, calcium, zinc, vitamin C and fat ratio,
were significantly lower in the women with albumin levels in the first quartile. Significantly
higher carbohydrate intakes were observed in the women who had serum albumin levels
in the first quartile. In the Mangaung study, significant differences were seen in the
intakes between infected women who had serum albumin levels in the first and fourth
quartiles. lntakes of total energy, protein, fat, MUFAT, SATFAT, carbohydrate,
magnesium, zinc, chromium, biotin, pantothenic acid and iodine were significantly lower
in the infected women with serum albumin levels in the first quartile. In the non-infected
women significantly lower intakes of calcium were observed in the group who had serum
albumin levels in the first quartile compared to those who had serum albumin levels in
the fourth quartile. These results also suggest that a more "westernized” diet was
associated with higher albumin levels in HIV-infected women. CONCLUSION: It is well known that nutrition has an integral part to play in the care of people living with
HIV/AIDS (PLWHA). Maintaining proper nutrition, weight and immune function is thought
to delay disease progression, prolong the asymptomatic phase and improve survival.
These analyses suggest that the "prudent" diet generally regarded as an optimal diet for
prevention of non-communicable diseases, may not be the optimal diet for PLWHA. The
overall analyses therefore suggest that a more "westernized" diet, higher in fat and
protein could be more beneficial to asymptomatic HIV-infected women compared to that
of a more "prudent" diet. As these studies were not primarily designed to investigate HIV
and nutrition, the role of a higher energy, fat and animal protein intake ("western" diet) in
asymptomatic HIV warrants urgent investigation.